Anti-Fraud and Financial Investigations

Health care fraud occurs when false or misleading information is submitted to improperly increase the amount of health care benefits paid. It is a crime.

The cost of fraud affects everyone. The U.S. General Accounting Office estimates that health care fraud costs consumers approximately $35 billion to $60 billion dollars annually. For employers, fraud increases the cost of providing benefits and their overall cost of doing business. This translates into higher premiums and out-of-pocket costs for employees.

Anti-Fraud Efforts

To protect members and providers from fraudulent practices, our Corporate and Financial Investigations Department looks into all instances of reported or suspected fraud. Between January 1, 2006, and December 31, 2010, the department’s efforts have recovered or saved from fraud, waste, or abusive billing over $256 million. Much of this success is due to members, doctors, and other providers who have been instrumental in reporting fraud.

If you know of or suspect health insurance fraud, please report it. You are not required to provide identifying information about yourself when reporting fraud.

Our toll-free Fraud Hotline is 1-866-282-2707.